Radiation Dose of Patients in Fluoroscopically Guided Interventions: an Update
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REVIEW
RADIATION PROTECTION
Radiation Dose of Patients in Fluoroscopically Guided Interventions: an Update Graciano Paulo1
•
Gabriel Bartal2 • Eliseo Vano3
Received: 8 August 2020 / Accepted: 22 September 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract The benefits of fluoroscopically guided interventional procedures are significant and have established new standards in the clinical management of many diseases. Despite the benefits, it is known that they come with known risks, such as the exposure to ionizing radiation. To minimize such risks, it is crucial that the health professionals involved in the procedures have a common understanding of the concepts related to radiation protection, such as dose descriptors, diagnostic reference levels and typical dose values. An update about these concepts will be presented with the objective to raise awareness amongst health professionals and contribute to the increase in knowledge, skills and competences in radiation protection in fluoroscopically guided interventional procedures. Keywords Radiation protection Fluoroscopicallyguided interventional procedures Dose descriptors Diagnostic reference levels
& Graciano Paulo [email protected] Gabriel Bartal [email protected] Eliseo Vano [email protected] 1
Medical Imaging and Radiotherapy Department, Instituto Polite´cnico de Coimbra, ESTESC - Coimbra Health School, Rua 5 de Outubro, S. Martinho Do Bispo, 3046-854 Coimbra, Portugal
2
Tel Aviv, Israel
3
Radiology Department, Complutense University, Madrid, Spain
Introduction Advances in technology and medical device development have changed the way health care is delivered to patients in the last decades. The development of minimally invasive fluoroscopy-guided interventions (FGIs) has made the times of heavy and complicated surgical procedures, leading to long periods of patient hospitalization, less frequent. The increasing use of FGIs in medical practice is due to the demonstrated benefits of these procedures [1], such as the reduction in scars and pain, faster postoperative recovery and less complications (e.g., Lesions of other structures, hemorrhage). Moreover, FGIs are now considered the gold standard of care in many diseases of both vascular and non-vascular origins, replacing traditional surgical procedures in several fields and widened the portfolio of therapeutic options. While the benefits of interventional radiology to patients are well recognized, there are also procedure-related risks. One of the risks related to FGIs is the potential for high patient radiation doses that may cause tissue reaction (also known as deterministic) radiation effects. Intelligent management of radiation exposure is therefore essential for these procedures [2]. ‘‘The tissue reactions, often of an acute nature, will only appear if the dose exceeds a threshold value. The new threshold suggested for tissue reactions by the ICRP is 500 mGy for cardiova
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